8.  Managing movement disorders

The movement disorder management team

The best treatment of movement disorders usually includes an active patient or advocate, along with their caregivers, and a team of healthcare professionals from various medical backgrounds. The members of this team may include:

Movement disorder specialist: A medical doctor trained in disorders of the nervous system who is a specialist neurologist. The Movement disorder specialist may diagnose the neurological problem; prescribe treatments including medications plus physical and occupational therapy; and refer you for surgical evaluation if necessary. The neurologist may also administer chemodenervation treatments.

Rehabilitation physician: A medical doctor who specialises in physical medicine and rehabilitation. They may design a rehabilitation program with other team members. They may also prescribe medications and administer chemodenervation treatments.

Physiotherapist: The healthcare professional who is responsible for any physical aspects of your treatment. They will prescribe exercises to help maintain range of motion in your limbs affected by a movement disorder. Physiotherapists might direct training to improve your ability to walk or move, and they may instruct you and your caregivers on how to position affected arms and legs to help reduce spasticity. They can also fit braces, splints, or casts prescribed by the treating physician. A physiotherapist often works closely with an occupational therapist to recommend special equipment or changes in your home to help accommodate your living needs.

Occupational therapist: Specialises in adapting your physical environment. They may teach you new ways of dressing, feeding, and grooming for example. They might also offer advice on adaptive devices such as wheelchairs and bath equipment, or home and workplace modifications to increase accessibility and ease of use.

Neurosurgeon: A medical doctor specifically trained to perform surgical procedures relating to the nervous system. For example, when a patient with severe spasticity responds well to an ITB therapy screening test, and is recommended to receive continuous intrathecal drugs, a neurosurgeon will implant the drug delivery pump. And for a patient with Parkinson's disease, Essential Tremor and dystonia, a neurosurgeon will perform the surgery associated with either ablative procedures or deep brain stimulation.

Neurosurgeons may also perform an operation to destroy selected sensory nerves at their entry point into the spinal cord (selective dorsal rhizotomy). This can provide relief from spasticity when other treatments cannot. If you require exposure of a target nerve for chemodenervation, the neurosurgeon may perform that operation; while a neurologist or rehabilitation physician will usually perform the chemodenervation.

Orthopaedic surgeon: A medical doctor who is specially trained to perform operations related to the bones, joints, muscles, and surrounding connective tissue. These types of procedures may help to reduce or correct muscle contractions that lead to abnormal positioning of joints. Orthopaedic operations often involve reconstruction or revision of tendons and bones. The orthopaedic surgeon may also assist with the fitting of braces and assessing growth and development, as well as implanting a drug delivery pump and performing chemodenervation.

If you are suffering from a movement disorder, discuss treatment options with your doctor, and ask for a referral to a movement disorder specialist near you.

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